title: Cesarean delivery surveillance system at a maternity hospital in Kabul, Afghanistan.
abstract: OBJECTIVE
  To use an active facility-based maternal and newborn surveillance system to describe cesarean delivery practices and outcomes in a resource-poor setting.
  
  
  METHODS
  Using data from operating room logbooks, 392 cesarean deliveries were evaluated between April 1 and June 30 2006 at a large public maternity hospital in Kabul, Afghanistan.
  
  
  RESULTS
  The perinatal mortality rate was 89 per 1000 births: 57% antepartum and 37% intrapartum stillbirths. Fetuses with normal birth weight comprised 85% of intrapartum stillbirths. Obstructed labor, uterine rupture, and malpresentation accounted for more than 50% of perinatal deaths. The cesarean delivery rate was 10.2% and there were 2 maternal deaths.
  
  
  CONCLUSIONS
  The high percentage of intrapartum stillbirths among normal birth weight fetuses suggests a need for improved labor monitoring and surgical obstetric practices. The use of a facility-based perinatal surveillance system is critical in guiding such quality assurance initiatives.
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Tharani
authors.initials: T
authors.lastname: Kandasamy
authors.forename: Mario
authors.initials: M
authors.lastname: Merialdi
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Guidotti
authors.forename: Ana P
authors.initials: AP
authors.lastname: Betrán
authors.forename: Jennifer
authors.initials: J
authors.lastname: Harris-Requejo
authors.forename: Farima
authors.initials: F
authors.lastname: Hakimi
authors.forename: Paul F
authors.initials: PF
authors.lastname: Van Look
authors.forename: F
authors.initials: F
authors.lastname: Kakar
mesh_terms: D000346:Afghanistan / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D008485:Medical Audit; D007744:Obstetric Labor Complications / Q000401:mortality*; D011159:Population Surveillance; D011247:Pregnancy; D050497:Stillbirth / Q000453:epidemiology*